Differential accumulation of lead and zinc in double-tidemarks of articular cartilage.

INTRODUCTION: Long-term exposure to increased lead (Pb) concentrations is associated with several chronic diseases. The divalent cation zinc (Zn) is essential for numerous enzymes. In a recent study we found remarkably elevated concentrations of Pb and Zn in the tidemark (TM), which is the mineralization front of human articular cartilage. OBJECTIVE: Duplication or multiplication of TMs occurs with advancing age or degeneration. We hypothesized that trace elements accumulate in TMs as a function of time. Thus, in cases of double TMs, the deep (older) TM should contain higher Pb and Zn concentrations than the superficial (younger) TM. DESIGN: Undecalcified tissue from articular cartilage and subchondral bone of femoral heads and patellae was examined by synchrotron radiation induced confocal micro X-ray fluorescence analysis and by quantitative backscattered electron imaging to determine the local distribution of Ca, Zn, and Pb in this tissue. RESULTS: The evaluation of X-ray fluorescence intensities in double TMs revealed in average a 2.6-fold higher Pb level in the deep TM compared to the superficial TM while Zn concentrations were similar. Pb and Zn contents were significantly enhanced in the deep TM (Pb: 35-fold, Zn: five-fold) and in the superficial TM (Pb: 12-fold, Zn: five-fold) compared to the bone level. CONCLUSION: For the first time a differential accumulation of Pb and Zn is documented in regions with double TMs revealing various timescales for the accumulation of these elements. Increased amounts of Pb are present in the TMs (up to the 62-fold of the bone level) featuring a potential source of internal Pb release if the TM region is destroyed.

Network architecture strongly influences the fluid flow pattern through the lacunocanalicular network in human osteons.

A popular hypothesis explains the mechanosensitivity of bone due to osteocytes sensing the load-induced flow of interstitial fluid squeezed through the lacunocanalicular network (LCN). However, the way in which the intricate structure of the LCN influences fluid flow through the network is largely unexplored. We therefore aimed to quantify fluid flow through real LCNs from human osteons using a combination of experimental and computational techniques. Bone samples were stained with rhodamine to image the LCN with 3D confocal microscopy. Image analysis was then performed to convert image stacks into mathematical network structures, in order to estimate the intrinsic permeability of the osteons as well as the load-induced fluid flow using hydraulic circuit theory. Fluid flow was studied in both ordinary osteons with a rather homogeneous LCN as well as a frequent subtype of osteons-so-called osteon-in-osteons-which are characterized by a ring-like zone of low network connectivity between the inner and the outer parts of these osteons. We analyzed 8 ordinary osteons and 9 osteon-in-osteons from the femur midshaft of a 57-year-old woman without any known disease. While the intrinsic permeability was 2.7 times smaller in osteon-in-osteons compared to ordinary osteons, the load-induced fluid velocity was 2.3 times higher. This increased fluid velocity in osteon-in-osteons can be explained by the longer path length, needed to cross the osteon from the cement line to the Haversian canal, including more fluid-filled lacunae and canaliculi. This explanation was corroborated by the observation that a purely structural parameter-the mean path length to the Haversian canal-is an excellent predictor for the average fluid flow velocity. We conclude that osteon-in-osteons may be particularly significant contributors to the mechanosensitivity of cortical bone, due to the higher fluid flow in this type of osteons.

The contribution of the pericanalicular matrix to mineral content in human osteonal bone.

The osteocyte lacunar-canalicular network (LCN) penetrates bone and houses the osteocytes and their processes. Despite its rather low volume fraction, the LCN represents an outstanding large surface that is possibly used by the osteocytes to interact with the surrounding mineralized bone matrix thereby contributing to mineral homeostasis. The aim of this study was to quantitatively describe such contributions by spatially correlating the local density of the LCN with the mineral content at the same location in micrometer-sized volume elements in human osteons. For this purpose, 65 osteons from the femur midshaft from healthy adults (n = 4) and children (n = 2) were structurally characterized with two different techniques. The 3D structure of the LCN in the osteons was imaged with confocal laser scanning microscopy after staining the bone samples with rhodamine. Subsequent image analysis provided the canalicular length density, i.e. the total length of the canaliculi per unit volume (µm/µm3). Quantitative information on the mineral content (wt%Ca) from the identical regions was obtained using quantitative backscattered electron imaging. As the LCN-porosity lowers the mineral content, a negative correlation between Ca content and network density was expected. Calculations predict a reduction of around -0.97 fmol Ca per µm of network. However, the experiment revealed for 62 out of 65 osteons a positive correlation resulting in an average additional Ca loading of +1.15 fmol per µm of canalicular network, i.e. an accumulation of mineral has occurred at dense network regions. We hypothesize that this accumulation happens in the close vicinity of canaliculi forming mineral reservoirs that can be utilized by osteocytes. Significant differences found between individuals indicate that the extent of mineral loading of the reservoir zone reflects an important parameter for mineral homeostasis.

Pulmonary embolism as a cause of cardiac arrest: presentation and outcome.

BACKGROUND: Pulmonary embolism (PE) is a possible noncardiac cause of cardiac arrest. Mortality is very high, and often diagnosis is established only by autopsy. METHODS: In a retrospective study, we analyzed clinical presentation, diagnosis, therapy, and outcome of patients with cardiac arrest after PE admitted to the emergency department of an urban tertiary care hospital. RESULTS: Within 8 years, PE was found as the cause in 60 (4.8%) of 1246 cardiac arrest victims. The initial rhythm diagnosis was pulseless electrical activity in 38 (63%), asystole in 19 (32%), and ventricular fibrillation in 3 (5%) of the patients. Pronounced metabolic acidosis (median pH, 6.95, and lactate level, 16 mmol/L) was found in most patients. In 18 patients (30%), the diagnosis of PE was established only postmortem. In 42 (70%) it was diagnosed clinically, in 24 of them the diagnosis of PE was confirmed by echocardiography. In 21 patients, 100 mg of recombinant tissue-type plasminogen activator was administered as thrombolytic treatment, and 2 (10%) of these patients survived to hospital discharge. Comparison of patients of the thrombolysis group (n = 21) with those of the nonthrombolysis group (n = 21) showed a significantly higher rate of return of spontaneous circulation (81% vs 43%) in the thrombolysis group (P=.03). CONCLUSIONS: Mortality related to cardiac arrest caused by PE is high. Echocardiography is supportive in determining PE as the cause of cardiac arrest. In view of the poor prognosis, thrombolysis should be attempted to achieve return of spontaneous circulation and probably better outcome.

Constant mineralization density distribution in cancellous human bone.

The degree of mineralization of bone matrix is an important factor in determining the mechanical competence of bone. The remodeling and modeling activities of bone cells together with the time course of mineralization of newly formed bone matrix generate a characteristic bone mineralization density distribution (BMDD). In this study we investigated the biological variance of the BMDD at the micrometer level, applying a quantitative backscattered electron imaging (qBEI) method. We used the mean calcium concentration (Ca(Mean)), the most frequent calcium concentration (Ca(Peak)), and full width at half maximum (Ca(Width)) to characterize the BMDD. In none of the BMDD parameters were statistically significant differences found due to ethnicity (15 African-American vs. 27 Caucasian premenopausal women), skeletal site variance (20 ilium, 24 vertebral body, 13 patella, 13 femoral neck, and 13 femoral head), age (25 to 95 years), or gender. Additionally, the interindividual variance of Ca(Mean) and Ca(Peak), irrespective of biological factors, was found to be remarkably small (SD < 2.1% of means). However, there are significant changes in the BMDD in the case of bone diseases (e.g., osteomalacia) or following clinical treatment (e.g., alendronate). From the lack of intraindividual changes among different skeletal sites we conclude that diagnostic transiliac biopsies can be used to determine the BMDD variables of cancellous bone for the entire skeleton of the patient. In order to quantify deviations from normal mineralization, a reference BMDD for adult humans was calculated using bone samples from 52 individuals. Because we find the BMDD to be essentially constant in healthy adult humans, qBEI provides a sensitive means to detect even small changes in mineralization due to bone disease or therapeutic intervention.

Foreign body asphyxiation--an autopsy study.

PURPOSE: Food asphyxiation is a common problem whenever and wherever people eat. A knowledge of predisposing factors might help to prevent this problem. SUBJECTS AND METHODS: We reviewed 34,476 consecutive autopsies done during a 14-year period (1984 to 1997) at the Institute of Forensic Medicine, Vienna. Demographic features and predisposing factors were determined for the 191 cases of fatal foreign body asphyxiation. RESULTS: Old age, poor dentition, and alcohol consumption were frequent findings. Other risk factors included chronic disease, sedation, and eating risky foods. On 120 (63%) of the 191 occasions, observers were present at the time of the incident and subsequently called the Emergency Service. In 110 (92%) cases, neither the observers nor the majority of the emergency medical technicians and physicians who would have been able to intervene recognized the definite diagnosis. Only 10 cases were correctly identified during cardiopulmonary resuscitation. CONCLUSIONS: These fatal accidents could be prevented easily. Effective prevention depends on understanding the nature and frequency of accidental deaths due to asphyxiation and the factors that lead to their occurrence and having a high degree of suspicion.

Rates of postmortem examination in Austria: the effect of distance between location of death and site of examination.

BACKGROUND AND OBJECTIVE: Despite the importance of autopsies for diagnosing disease and determining cause of death, autopsy rates are decreasing in many countries. Furthermore, autopsy rates are often not distributed randomly between different regions within countries. In this study we analyzed an apparent nonrandom spatial distribution of autopsy rates in Austria for the period 1991-2000. We tested the new hypothesis that the rate of autopsies performed on people who die at home depends on the distance from the residence to the hospital or forensic institute where autopsies are performed. METHODS: Data were extracted from the official mortality records for the years 1991-2000. Only persons who deceased in private residences were included. A logistic regression model was used. RESULTS: Even controlling for variability in sex, age, date of death, and family status, the effect of distance significantly implied lower autopsy rates in the alpine parts of Austria. CONCLUSIONS: This effect of distance may lead to artificially nonrandom mortality patterns in disease maps. As a consequence, the possibility of hypothesizing incorrect health risks to explain nonrandom mortality patterns increases.

Central venous catheter pinch-off and fracture: recognition, prevention and management.

The so-called pinch-off syndrome is observed in up to 1% of all central venous catheters (CVCs), and is a valuable warning prior to fragmentation, which occurs in approximately 40% of the respective cases. As long-term indwelling CVCs are used with increasing frequency, this paper describes the necessity of pinch-off monitoring following the experiences of a case study and a review of the current literature on this specific topic in order to point out preventive practice guidelines. Besides easy preventive practices such as a high level of suspicion and adequate X-ray controls, findings give strong evidence that the most important specific factor might be the adequate approach. In our hands, the supraclavicular technique has provided the best results with regards to percutaneous introduction of large bore CVCs.

Different fatal toxicity of neuroleptics identified by autopsy.

Autopsies and toxicological analyses at the Institute of Forensic Medicine revealed 85 fatal intoxications with neuroleptics in Vienna from 1991 to 1997. A total of 17 cases were linked to a single neuroleptic (NL) alone, while 68 deaths were attributed to a combination of NLs with other drugs. The most frequently detected agent was prothipendyl (n=41). During the study period the number of defined daily doses of high-potency NLs prescribed increased significantly (P< or =0.001) due to increased prescribing of new atypical antipsychotics. The quantity of intermediate- and low-potency NLs dispensed remained stable. The most frequently prescribed NL was haloperidol. The relative toxicities of different NLs were calculated by dividing the number of deaths caused by this NL into the number of defined daily doses prescribed in the observation period (f-value). Single-substance intoxications and multiple-substance intoxications were distinguished. The highest f-values were associated with low-potency NLs, especially with prothipendyl, chlorprothixene and levomepromazine. Low f-values were found for the group of high-potency NLs, including flupentixol, fluphenazine, haloperidol and pimozide, as well as olanzapine. Compared to the f-values for all NLs prescribed, f-values for low-potency NLs were shown to be significantly higher concerning single-substance intoxications (P< or = 0.05) and multiple-substance intoxications (P < or = 0.001), while f-values for high-potency NLs were significantly lower (P< or = 0.05 and P< or = 0.001). We are not aware of the psychiatric diagnoses in our post-mortem sample. However, the present results indicate that careless use of low-potent NLs should be avoided in patients with a potential risk of accidental or suicidal overdose.

Suicide by antidepressant intoxication identified at autopsy in Vienna from 1991-1997: the favourable consequences of the increasing use of SSRIs.

In the area of Vienna, any person dying under questionable circumstances is examined at the Institute of Forensic Medicine, where the cause of death is determined by means of autopsy and chemical analysis. Our study on fatal intoxications was performed in the period between 1991 and 1997, when selective serotonin reuptake inhibitors (SSRIs) were establishing themselves on the market, reaching the top of prescription statistics. Tricyclic antidepressants (TCAs) were involved in 30 single- and 127 multiple-substance intoxications, with amitriptyline and doxepin being the most frequently used drugs. SSRIs were involved in five multiple-substance intoxications. The f-value, which refers to the number of deaths per million defined daily doses prescribed, was found to be significantly (P

After antagonization of acute opiate overdose: a survey at hospitals in Vienna.

This study describes the clinical management and characteristics of people who, following acute opioid overdose, are taken to hospital after efficient antagonization by the pre-hospital emergency service. In addition, it defines areas of interest for further research. Over a 4-month period (September-December 1993) we collected data by a structured protocol sheet on patients' characteristics, anamnestic data on abuse and emergencies, clinical presentation, treatment by specific antidote and routine laboratory investigations. Outcome was verified by retrospective review of prehospital and forensic data. We studied 77 subjects, predominantly young males, who were involved in 83 emergencies, mostly occurring at weekends. In more than 60% of cases a single administration of specific antidote sufficed to stabilize the patients; 64% of patients left hospital against medical advice after an average stay of less than 6 hours; 46% denied daily opioid abuse and half the subjects, especially younger drug-users, seemed interested in counselling. This hospital-based study did not provide reliable data on the epidemiology of opioid overdose. Clinical management is determined by experience, pragmatism and beliefs. Efforts towards secondary prevention of drug problems at emergency departments might be warranted, and further research on pattern and management of opioid overdose is needed.

Spontaneous subarachnoid haemorrhage as a cause of out-of-hospital cardiac arrest.

OBJECTIVE: Spontaneous subarachnoid haemorrhage as a cause of out-of-hospital cardiac arrest is poorly evaluated. We analyse disease-specific and emergency care data in order to improve the recognition of subarachnoid haemorrhage as a cause of cardiac arrest. DESIGN: We searched a registry of cardiac arrest patients admitted after primarily successful resuscitation to an emergency department retrospectively and analysed the records of subarachnoid haemorrhage patients for predictive features. RESULTS: Over 8.5 years, spontaneous subarachnoidal haemorrhage was identified as the immediate cause in 27 (4%) of 765 out-of-hospital cardiac arrests. Of these 27 patients, 24 (89%) presented with at least three or more of the following common features: female gender (63%), age under 40 years (44%), lack of co-morbidity (70%), headache prior to cardiac arrest (39%), asystole or pulseless electric activity as the initial cardiac rhythm (93%), and no recovery of brain stem reflexes (89%). In six patients (22%), an intraventricular drain was placed, one of them (4%) survived to hospital discharge with a favourable outcome. CONCLUSIONS: Subarachnoid haemorrhage complicated by cardiac arrest is almost always fatal even when a spontaneous circulation can be restored initially. This is due to the severity of brain damage. Subarachnoid haemorrhage may present in young patients without any previous medical history with cardiac arrest masking the diagnosis initially.

Fatal transdental posterior rotary subluxation of the cervical spine. A case report.

STUDY DESIGN: The cervical spine of an 86-year-old man known to have a fracture of the odontoid process was removed at autopsy and dissected. OBJECTIVES: To establish the cause of death, which was not apparent. SUMMARY OF BACKGROUND DATA: Ruptures of the vertebral arteries in patients with fractures of the odontoid process are rare. Only a few reports are published in the literature. Those that address postmortem findings in patients with fractures of the odontoid process do not make any reference to associated capsular and ligamentous injuries and the resultant instabilities. METHODS: Because of legal constraints, the cervical spine was removed en bloc 1 week after the patient's death and carefully dissected. RESULTS: In addition to the known bony injury, rupture of the left vertebral artery, epidural hematoma, disruption of the posterior atlantoaxial ligaments, hemorrhage into the anterior ligamentous structures, rupture of the capsule of the right atlantoaxial joint, and stretching of the capsule of the left joint were found to be present. Displacement of the spinal cord by an epidural hematoma secondary to rupture of the left vertebral artery was recorded as the apparent cause of death. The rupture had obviously been caused by the abnormal rotation of the atlas on the axis in a clockwise direction. CONCLUSIONS: Both the fatal outcome and the pathologic examination showed that established management concepts, particularly screw fixation of a fractured odontoid process, should be reconsidered in light of the potential occurrence of transdental posterior rotary subluxation. Because the incidence of capsular, ligamentous, and vascular injuries associated with fractures of the odontoid process is still poorly understood, more autopsies would be needed. The case also raises the question of whether, in an elderly patient like ours, a fracture of the odontoid process should prompt immediate surgical stabilization.

In vitro genesis of subaxial cervical unilateral facet dislocations through sequential soft tissue ablation.

STUDY DESIGN: In vitro anatomic study investigating the degree of soft tissue disruption required to produce a subaxial cervical unilateral facet dislocation. OBJECTIVES: To develop an understanding of the relative contributions to stability of the subaxial cervical soft tissues and to define an anatomic threshold of injury necessary to produce a unilateral cervical facet dislocation. SUMMARY OF BACKGROUND DATA: The literature at this time is unclear regarding the precise pathomechanics of a cervical unilateral facet dislocation and the required threshold of soft tissue injury necessary for its genesis. Published clinical reports do not make any specific reference to these factors or are unclear in their objectivity. METHODS: Two adjacent vertebra at a time in 10 fresh-frozen subaxial cervical spine specimens (C2-C3 to C6-C7) were transfixed in the coronal plane with 3.5-mm Schanz screws. A steady unilateral vertical distraction force resulting in lateral cervical flexion was applied to these screws as the surrounding cervical soft tissue structures were sequentially ablated. Four experimental models were developed, varying the order of soft tissue disruption. RESULTS: The physiologic coupling of subaxial cervical unilateral distraction and rotation, because of the spatial orientation or inclination of the cervical facet joints, allowed the creation of a unilateral facet dislocation without an additional flexion moment. Disruption of the ipsilateral articular capsule, ligamentum flavum, and more than half of the anulus fibrosus was necessary for the genesis of a unilateral facet dislocation. Disruption of the supraspinous and interspinous ligaments was not necessary but appeared to facilitate or lessen the force required to dislocate a unilateral facet. Disruption of the anterior and posterior longitudinal ligaments and intertransverse ligaments was not necessary to create a unilateral facet dislocation. CONCLUSION: This anatomic study further supports the theory that discontinuity of the anterior and posterior longitudinal ligaments is not necessary for a unilateral facet dislocation to occur. The ipsilateral facet capsule, anulus fibrosus, and ligamentum flavum appear to be the physical soft tissue restraints that need to be disrupted to produce a unilateral facet dislocation.

The effects of staged static cervical flexion-distraction deformities on the patency of the vertebral arterial vasculature.

STUDY DESIGN: Thirty-five fresh frozen cervical spine specimens underwent vertebral artery cannulization and angiography to determine the static influence of the four stages of subaxial flexion-distraction injuries as described by Allen et al on vertebral artery patency. OBJECTIVES: To evaluate the degree of vertebral vessel deformation and potential injury in staged static flexion-distraction deformities of the cervical spine. SUMMARY AND BACKGROUND DATA: Asymptomatic vertebral artery injury is found in up to 19% of all patients who incur trauma to the lower cervical spine. This incidence increases in flexion-distraction deformities. It is unclear as to the individual contributions of various force loads and resultant deformity on the etiology of these injuries. RESULTS: No significant deformation in vertebral artery flow was noted in the flexion-distraction Stage I injuries within the physiologic range of cervical flexion. Flexion-distraction Type II and III injuries (unilateral and bilateral facet dislocations, respectively) demonstrated considerable impairment to vertebral artery dye flow in proportion to the degree of vertebral deformity. Manipulating the dislocated vertebral segments into a localized lordosis (flexion-distraction Stage II) further impaired vertebral vessel patency. Coexistent rupture of the vertebral radicular vessels was a constant finding in Stage II and III injuries. Longitudinal stretch deformities of the vertebral artery were limited primarily to the injured vertebral segment. Stage IV injuries resulted in irreversible disruption of vertebral dye flow. CONCLUSION: The static deformity of flexion-distraction Stage II to IV subaxial cervical injuries results in significant objective compression of the vertebral vasculature. The precise contribution of static cervical malalignment related to advanced staged flexion distraction injuries on irreversible vertebral vessel flow disruption is presently uncertain.

Fenestration of the extracranial vertebral artery: review of the literature.

STUDY DESIGN: A case report on fenestration of the extracranial vertebral artery found at forensic autopsy. OBJECTIVE: To describe an extracranial vertebral artery fenestration involving the subaxial cervical region, assessed radiographically and angiographically at forensic autopsy, in a young man. SUMMARY OF BACKGROUND DATA: Duplications or fenestrations of the extracranial course of the vertebral artery are rare and seen almost exclusively as a coincidental finding in angiographic studies. The terms "fenestration" and "duplication" are often incorrectly used synonymously. The former describes the passage of the duplicated vessel within the vertebral foramen transversarium, whereas the latter refers to the duplicated vessel coursing additionally through the spinal canal. The reported cases describing duplication are more common. Only three cases of vertebral extracranial fenestrations, involving only the upper cervical spinal segments, have been described in the literature. RESULTS: Angiography showed a fenestration of the vertebral artery localized between the intervertebral spaces of C2-C3 and C3-C4. At dissection, the vertebral artery appeared as a single vessel in the area of the fenestration. Histologically, a distinct difference in the thickness and composition of the vessel walls was found between the two vessel trunks. At autopsy, no further anomalies were observed in the vessels supplying the brain, which is contrary to the commonly held belief that fenestration is frequently associated with vascular malformations. CONCLUSION: Fenestration of the extracranial course of the vertebral artery is a developmental or congenital anomaly. A review of the literature demonstrated that this is apparently only a coincidental finding and has no pathologic significance.

Textbooks on legal medicine in the German-speaking countries.

In this survey, the textbooks on legal medicine which were published in the German-speaking countries from the 17th century up to now are briefly reviewed. The textbooks with the most impact on the further development of legal medicines were those published by Johann Ludwig Casper in Berlin and Eduard Ritter von Hofmann in Vienna in the 19th century. The main textbooks of the 20th century are addressed as well, also the different development in both German countries.

Technique for dissecting the cervical vertebral column.

Dissecting the cervical vertebral column usually is presumed in the course of a routine autopsy to be difficult and time-consuming. Additionally, most techniques described in the literature lead to extensive mutilation of the corpse. We present a method which can be performed quickly and is learned easily. The major advantage of our technique is that the integrity of the corpse, in particular of the facial surface, is maintained.

Effects of toluidine blue and destaining reagents used in sexual assault examinations on the ability to obtain DNA profiles from postcoital vaginal swabs.

Toluidine blue is an important tool to detect and document genital and perianal injuries following sexual assault. Application of toluidine blue dye and its subsequent removal from unstained areas by means of a destaining reagent, such as diluted acetic acid or a lubricant has been shown to increase the detection rate of posterior fourchette lacerations from 16% to 40% in adult rape victims. Currently, limited information on toluidine blue positive findings in sexually active control groups imposes some limitation on the interpretation of these injuries. Because injuries could otherwise be attributed to improper handling of an examination speculum or the improper insertion of the examining finger, the toluidine blue test should be performed prior to any digital or speculum examination and thus prior to the collection of forensic evidence. For forensic DNA identity testing, it becomes pertinent to determine whether toluidine blue and the destaining reagents used in a sexual assault examination have an adverse effect on the recovery of high molecular weight DNA from postcoital vaginal swabs and thereby have an impact on restriction fragment length polymorphism (RFLP) analysis or PCR-based tests. It is known that some of the lubricants used can have a destructive effect on sperm motility. In order to investigate the potential effects, postcoital vaginal swabs were taken 6 h after sexual intercourse and exposed directly to 1% toluidine blue in aqueous solution, 1-10% acetic acid, and various surgical and vaginal lubricants. Subsequently, the DNA was isolated and DNA identity typing (RFLP and PCR-based) was performed. The results demonstrate, that these reagents have no negative effect on the ability to obtain DNA profiles, either RFLP or PCR-based, from shallow and deep vaginal swabs. The quantity and quality of extractable high molecular weight DNA obtained was comparable with that from uncontaminated postcoital vaginal swabs. RFLP patterns and PCR-based typing results on the D1S80, HUMTH01, TPOX, and CSF1PO loci were consistent with the uncontaminated control swabs and the corresponding whole blood samples of the donors. Therefore, evidentiary material inadvertently contaminated with these reagents can be successfully typed.

Suicidal chloroquine poisoning: clinical course, autopsy findings, and chemical analysis.

Suicidal overdose of chloroquine is rare. We present a 14-year-old girl who was admitted to our Emergency Department after intentional ingestion of 7.5 g of chloroquine base followed by cardiac and respiratory arrest. Despite early mechanical ventilation, cardiac support, and treatment with high doses of diazepam, the patient died. Laboratory investigation indicated disseminated intravascular coagulation confirmed by petechial hemorrhages in the leptomeninges at autopsy, a finding that has not previously been described. Postmortem tissue analysis demonstrated early drug distribution to the medulla oblongata and cerebellum.